In addition to complications of delivery, many deaths of pregnant women occur as a result of H.I.V. infection and malaria, problems that even good obstetrical services will not avert.
Furthermore, the costs associated with delivering a baby in a health facility are unpredictable, since many complications of delivery are not foreseen during pregnancy.
After participating women had given birth, maternal and child hospital records were reviewed to obtain data on complications of delivery.
Exposures were divided into five thematic categories: pre-existing parental fitness; early pregnancy exposures; toxic exposures; complications of pregnancy; and complications of delivery (see the online supplement for definitions of predictor variables).
It is also possible to speculate that European immigrants may be more likely than others to travel and deliver in their places of origin, particularly when facing complications of delivery, thus deflating the numerators.
We found no associations between Tourette syndrome/chronic tic disorder and the other prior candidate risk factors, most importantly, prenatal maternal smoking, low birth weight, gestational age and complications of delivery.
With adequate training and supervision provided by AKHS,P, there were no safety issues in this study, and TBAs were able to recognise and arrange prompt referrals for complications of delivery.
Complications of delivery included method of delivery, Apgar scores of <7 at 5 min, inspired oxygen or mechanical ventilation at birth, resuscitation, pre-term labour or premature rupture of membranes, gestation of <37 or ⩾42 weeks, and birth weight (in grams) were adjusted for gestational age.
We hypothesised, based on the previous literature, that maternal prenatal smoking and alcohol use, excessive vomiting during pregnancy, complications of delivery (e.g. assisted delivery) and low birth weight or young gestational age at birth would be associated with Tourette syndrome and chronic tics in this population.
